Concussion in kids: Insomnia treatment linked to faster recovery

Active kids sustain injuries

Every year, more than 100,000 Canadian children and adolescents get a concussion while participating in normal childhood activities, like sports and play. Most kids return to school and activities within about one month of the injury, but sometimes they need specialized concussion treatment and rehabilitation.

Concussion and sleep

Although the majority of youth with concussion will recover within about one month, 20 to 30 per cent will have symptoms that have not resolved. Those with slow concussion recovery are more likely to repeatedly visit health-care professionals, miss school, and have parents who need to take time off of work. Finding ways to improve recovery has become a top priority.

Insomnia after concussion

Research shows that insomnia is one of the most common lingering symptoms in adolescents with concussion. Insomnia is defined as difficulty falling asleep or staying asleep, restriction in the number of hours of sleep, or feeling that sleep is not refreshing.

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In a recent study, we found that some level of insomnia was present in two-thirds of adolescents with slow recovery from concussion. One-third had moderate to severe insomnia. Worse insomnia was also linked to worse post-concussion symptoms, worse anxiety and depression, and more self-reported problems with attention and memory.

Psychotherapy for insomnia

Unfortunately, there are very few evidence-based treatments to help with insomnia after concussion, so clinicians are often providing suggestions that may or may not actually work.

Our treatment trial found that a type of psychotherapy, called cognitive behavioural therapy for insomnia (or CBT-I), provides remission of insomnia in 80 to 90 per cent of adolescents who were taking several months to recover from their brain injury. That is compared to remission rates of only nine per cent for those who did not have the treatment.

The benefits of this therapy extended beyond just sleep improvement; there was also improvement in overall concussion recovery. That is, their level of post-concussion symptoms also dropped over time.

Sleep schedules are important

Commonly, after concussion, sleep routines get temporarily disrupted. Kids who go on to develop longer term sleep problems often do not return to a normal sleep routine. Instead of going to bed and getting up at a regular time, they go to bed and wake up later. They may also sleep less at night and start to compensate by taking more naps.

This disrupted schedule interferes with school and regular activities. As activities start to drop off, the motivation to get to bed and wake up at regular times also goes down.

Improve sleep, concussion may remit

The second most important piece of advice we give is to use your bed only for sleeping! This means that if a child is not sleeping, they shouldn’t be lying in bed. If they need to rest but aren’t sleepy, doing so on the couch is just fine.

Finally, there should be no electronic devices in bedrooms, as they are notorious for disrupting sleep, even when they are turned off! The American Academy of Pediatrics recommends that bedrooms are 100 per cent media-free zones and one of the most effective pieces of advice we have is to remove all electronics from bedrooms.

Conclusion

The main message we want to convey is that concussion-related insomnia is a treatable problem. And that by improving sleep, concussion symptoms may also remit.

FAQs

Q: How common is concussion in kids?

A: More than 100,000 Canadian children and adolescents get a concussion every year while participating in normal childhood activities.

Q: What are the symptoms of concussion?

A: The symptoms of concussion can vary from person to person, but they often include headache, dizziness, fatigue, and difficulty concentrating.

Q: How long does it take for kids to recover from concussion?

A: Most kids return to school and activities within about one month of the injury, but sometimes they need specialized concussion treatment and rehabilitation.

Q: What is insomnia, and how is it related to concussion?

A: Insomnia is difficulty falling asleep or staying asleep, restriction in the number of hours of sleep, or feeling that sleep is not refreshing. It is one of the most common lingering symptoms in adolescents with concussion.

Q: What is CBT-I, and how does it help with insomnia after concussion?

A: CBT-I is a type of psychotherapy that helps people change their sleep habits and thoughts to improve their sleep. It provides remission of insomnia in 80 to 90 per cent of adolescents who were taking several months to recover from their brain injury.

Q: How can parents help their kids recover from concussion?

A: Parents can help their kids recover from concussion by getting them back on a regular sleep schedule, removing electronic devices from bedrooms, and using their bed only for sleeping.

Q: Where can parents find more information about treating insomnia after concussion?

A: There are many good books and other resources available for teens and parents who want to learn more about treating insomnia after concussion.